Evaluation of Swedish Ice Cleat Distribution Programs : From Program Design to Ice Cleat Use

Abstract: Winter conditions, characterized by snow and lowered temperatures, can make travel by foot difficult. Older adults aged 65 and above are especially at risk of slipping and falling on icy or snowy surfaces. Minor falls can result in severe injuries due to their frailty. Traditional methods of reducing this risk, like plowing or using sand and salt, may not always be effective preventive measures. Several municipalities in Sweden have taken action to combat this issue and introduced subsidized ice cleat distribution programs for older adults. It is unclear how these programs are designed and whether they are effective in promoting the use of ice cleats. This thesis uses a mixed-method approach drawing on data collected from multiple sources to analyze and evaluate the programs. Paper I presents a program theory model, outlining the essential components required for implementing a program and describing the causal connections from the program's introduction and necessary conditions to its anticipated impact. Survey data from intervention municipalities suggest that about 40% of the target group participated by retrieving a pair of devices, and 90% of all ice cleats were eventually distributed. Paper II presents an outcome evaluation suggesting that individuals exposed to a distribution program increase ice cleat use. Analyses of the self-reported data on ice cleat use show an increase of 7.5 percentage points. Estimations suggest that general use could be 17.3% if one pair of cleats were distributed to all eligible citizens. Future research is needed to investigate the programs' effect on fall-related injuries on ice and snow. In addition, in-depth interviews with program policymakers should be considered to provide further insights into the design and implementation of these programs.